LPNI Health Topic – August 2016


Heart Failure/Congestive Heart Failure

The term Heart Failure (HF) is used when the heart is unable to keep up with its workload to pump enough  blood to meet the needs of the body.   Congestive Heart Failure (CHF) is HF with edema (fluid in the tissue) of feet, legs and if severe in the abdomen and organs such as the lungs and liver.  It is estimated that 1 in 5 Americans will develop HF in their life time.  Nearly 6 million Americans had HF in 2015. One in 9 deaths include HF as a contributing cause. Worldwide an estimated 23 million people develop heart failure. Not all conditions that cause  HF can be reversed but treatments can help reduce/control  the signs and symptoms and most people with HF can lead a productive active life.


Two Types of Heart Failure Systolic (also called heart failure with reduced ejection fraction or left heart failure) and Diastolic (also called heart failure with preserved ejection fraction or right-heart failure) are the 2 main types of HF.  Ejection fraction refers to the percentage of blood the heart pumps  with each contraction. A normal ejection fraction is 55 to 65 percent. In left side failure that may drop  to 10 to 40%.  Systolic HF occurs when the left ventricle becomes large and contractions are weak.  In Diastolic HF the pumping action is strong but the muscle is stiff and the ventricle cannot fill normally. Acute HF can happen suddenly after a severe heart attack, or when a virus infects the heart muscle or when a blood clot is in the lung.  More commonly individuals have Chronic HF which develops over months or years.


Signs and Symptoms include all of the following. *shortness of breath with activity and in severe HF at rest  *fatigue and weakness  *swelling of feet and ankles   *rapid or irregular heart beat

*reduced ability to exercise     *persistent cough or wheezing with pink or red-tinged phlegm

*sudden weight gain   *increased need to urinate at night     *abdominal swelling

*lack of appetite and nausea   *difficulty concentrating or decreased alertness

* and if caused by a heart attack usually chest pain and other signs of heart attack


Risk factors for HF include high blood pressure, infection or inflammation of the heart muscle,  abnormal heart rhythms, chronic diseases such as diabetes, HIV, thyroid problems, sleep apnea, and congenital heart defects.  Several other unusual conditions can contribute to HF as well as lifestyle behaviors and practices such as over use of alcohol, tobacco, substance abuse, and obesity


Diagnosis The primary health care provider will order some blood tests, chest x-ray, ECG (electrocardiogram which tests the electrical activity of the heart) and an Echocardiogram (which checks any problems with function).  If more information is needed a stress test and possibly a CT scan or an MRI may be ordered.  If there are problems with the blood vessels of the heart, a coronary angiogram will be ordered. 


Treatment  Treatment will depend on what the tests show the cause to be and will usually require some medications such as diuretics and various heart medication. It is important to know how to take the medication and what can interfere with their action such as some supplements and over-the-counter meds that one might already be taking. Sometimes the individual may need to alter the diet such as eating no grapefruit, or limiting greens, etc.  For some causes surgery procedures will be needed such as coronary bypass, valve repair or replacement, or implanting a pacemaker.  In very severe or advanced HF, the individual may need a heart pump assist or heart transplant.


Hearts are very important.  Scripture tells is in Proverbs 4:23 Above all else guard your heart, for it is the wellspring of life.


More information is available at:



www.nlm.nih.gov/medlineplus/heartdisease   www.who.int/cardiovascular_diseases


HEART FAILURE Advances in Prevention & Treatment 2016  A special Report published by the editors of HEART  ADVISOR in conjunction with Cleveland Clinic


Dorothy E. Degnitz BSN

Parish Nurse Good Shepherd Lutheran Church and School

Watertown, WI. USA